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MTLBE > (M) L2.3: RA 11223 - Universal Healthcare Act > Flashcards

(M) L2.3: RA 11223 - Universal Healthcare Act Flashcards

1
Q

This law aims to ensure ______ access to quality and affordable healthcare and protection against financial risk

A

Equitable

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2
Q

The law aims to progressively realize universal healthcare through what 2 aspects?

A
  1. Systemic approach
  2. Clear role delineation
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3
Q

Declaration of Principles (fill in the blanks):
An ______ and ________ approach to:

  1. ensure health literacy, healthy living, and protection from hazards and risk
  2. provide comprehensive health services without financial hardship
A

Integrated and Comprehensive

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4
Q

Declaration of Principles (fill in the blanks):
A whole of ______, ______, and ________ approach in the development of policies

A

System, Government, and Society (SGS)

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5
Q

Declaration of Principles (fill in the blanks):

A ______-centered approach revolving around everyone’s needs and well-being policies

A

People

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6
Q

What is the FULL TITLE of RA 11223?

A

An Act Instituting Universal Healthcare for All Filipinos, Prescribing Reforms in the Healthcare System, and Appropriating Funds Thereof

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7
Q

It is the policy of the State to protect and promote the right to _____ of all Filipinos and instill health consciousness among them

A

Health

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8
Q

What Declaration of Principles and Policies does this statement fall under?

To ensure that all Filipinos are literate, provided with healthy living conditions, and are protected from hazards that could affect their health

A

An integrated and comprehensive approach

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9
Q

What Declaration of Principles and Policies does this statement fall under?

This provides access to quality and cost-effective, promotive, preventive, curative, rehabilitative, and palliative health services without causing financial hardship

This also prioritizes the needs of the population who cannot afford such services

A

A health care model

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10
Q

What Declaration of Principles and Policies does this statement fall under?

This fosters a whole-of-system, whole-of-government, and whole-of-society approach in the development, implementation, monitoring, and evaluation of health policies, programs, and plans

A

A framework

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11
Q

What Declaration of Principles and Policies does this statement fall under?

This is centered on people’s needs and wellbeing and is cognizant of the differences in culture, values, and beliefs

A

A people-oriented approach for the delivery of health services

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12
Q

This law aims to establish what 3 healthy environments?

A

Living, Schooling, and Working Environments

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13
Q

Ideally, every family must have what type of healthcare provider?

A

Primary care provider team

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14
Q

T or F: Health spending is unpredictable as there is no clear basis for what health services PhilHealth can cover per member

A

False (it is predictable in a sense that you know that not everything, only some, will be covered by the government)

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15
Q

Financing: Eliminating Redundancies

Identify whether this is population-based or individual-based health services:

> shall be financed by the national government through the DOH and LGUs provided free of charge at point of service for all Filipinos

A

Population-based

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16
Q

Financing: Eliminating Redundancies

Identify whether this is population-based or individual-based health services:

Interventions such as health promotion disease surveillance, and vector control, which have community groups as recipients

A

Population-based

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17
Q

Financing: Eliminating Redundancies

Identify whether this is population-based or individual-based health services:

> shall be financed through repayment mechanisms to ensure predictability of health expenditures to the Philippine Health Insurance Corporation (PHIC) e.g. social health insurance, private health insurance, and HMOs

A

Individual-based

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18
Q

Financing: Eliminating Redundancies

Identify whether this is population-based or individual-based health services:

Services which can be accessed within a health facility or remotely that can be definitively traced back to one (1) recipient, has limited effect at a population level and does not alter the underlying cause of illness such as ambulatory and inpatient care, medicines, laboratory tests and procedures among others

A

Individual-based

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19
Q

This entity shall support the LGUs in financing of capital investments and provision of population-based interventions

A

The National Government

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20
Q

Financing: Simplifying Membership

These are members who:
> have the capacity to pay premiums
> are employed and are bound by an employer-employee relationship
> are self-earning, professional practitioners, migrant workers, including their qualified dependents and lifetime members

A

Direct Contributors

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21
Q

Financing: Simplifying Membership

These are members who are not included in the other category as well as their qualified dependents, whose premium shall be subsidized by the national government including those who are subsidized as a result of special laws

A

Indirect Contributors

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22
Q

Financing: Simplifying Membership

These members pay premium rates that shall be in accordance with a schedule, and monthly income floor and ceiling

A

Direct Contributors

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23
Q

Financing: Simplifying Membership

These members’ premium subsidies shall be gradually adjusted and included annually in the General Appropriations Act (GAA)

A

Indirect Contributors

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24
Q

What act allows for the adjustment of subsidies given to indirect contributors?

A

General Appropriations Act (GAA)

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25
Q

T or F: For direct contributors, the funds shall be released to PhilHealth

A

False (indirect)

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26
Q

Who shall the DOH and PhilHealth request for appropriate supplemental funding from to meet targeted milestones for indirect contributors?

A

Congress

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27
Q

T or F: For every decrease in the rate of contribution of direct contributors and premium subsidy of indirect contributors, there shall be a corresponding increase in benefits

A

False (increase in rate = increase in benefits and vice versa)

*The more the government charges, the more benefits you get

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28
Q

Financing: Pooling Funds to PhilHealth

This source of fund describes an excise tax on specific goods and services due to their ability, or perception, to be harmful or costly to society

A

Total incremental sin tax collections

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29
Q

Financing: Pooling Funds to PhilHealth

What percentage of National Government share from the income of the Philippine Amusement Gaming Corporation (PAGCOR) shall be given to PhilHealth?

A

50%

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30
Q

Financing: Pooling Funds to PhilHealth

What percentage of the Charity Fund, net of Documentary Stamp Tax Payments, and mandatory contributions of the Philippine Charity Sweepstakes Office (PCSO) shall be given to PhilHealth?

A

40%

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31
Q

T or F: The regular contributions of PhilHealth members is a major source of funding for the corporation

A

False (premium)

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32
Q

Annual appropriations of what government entity included in the General Appropriations Act (GAA) shall be given to PhilHealth?

A

DOH

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33
Q

T or F: National Government subsidy to PhilHealth included in the General Appropriations Act (GAA) is a source of funding

A

True

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34
Q

PhilHealth shall shift to _____-driven, close end, prospective payments

A

Performance-driven

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35
Q

T or F: PhilHealth aims to have no differentiation between facility and professional fees

A

True

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36
Q

T or F: PhilHealth shall develop differential payments considering service quantity

A

False (service quality)

*your costs will mostly depend on the quality of care you receive, not per quantity

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37
Q

The DOH and LGUs shall provide a system that will afford primary care providers acting as what?

(3 answers)

A
  1. Navigator
  2. Coordinator
  3. Initial and continuing point of contact
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38
Q

Only when can a higher level of care be coordinated by the family’s primary care provider?

A
  1. Emergencies/serious cases
  2. When proximity is a concern
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39
Q

T or F: Every Filipino shall register with a public or private primary care provider of their choice

A

True

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40
Q

Province/city-wide health systems shall pool and manage all resources intended for health services to finance population and individual-based health services, health system operating costs, capital investments, remuneration of additional health workers, and incentives for all health workers through what?

A

Special Health Fund

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41
Q

Who shall develop guidelines for the use of the Special Health Fund?

A

DOH in consultation with the Department of Budget and Management and LGUs

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42
Q

These 4 entities shall endeavor to integrate health systems into province-wide and city-wide health systems

A

DOH, DILG (Dept. of Interior and Local Government), PhilHealth, and the LGUs

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43
Q

These shall oversee and coordinate the integration of health services for province-wide and citywide health systems

A

The Provincial and City Health Boards

44
Q

T or F: The Provincial and City Health Boards are to be composed of municipal and component city health systems, and city-wide health systems in highly urbanized and dependent
component cities, respectively

A

False (independent)

45
Q

Municipalities and cities included in health systems shall be entitled to a _______ in the Provincial or City Health Board

A

Representative

46
Q

T or F: PhilHealth shall endeavor to contract public, private, or mixed health care provider networks for the delivery of individual-based health services

47
Q

These shall agree to service quality, copayment/co-insurance, and data submission standards

A

Healthcare provider networks

48
Q

During the transition, PhilHealth and DOH shall ______ health care providers that form networks

A

Incentivize

49
Q

What institutions may be contracted as stand-alone health care providers by PhilHealth?

A

Apex or End-Referral Hospitals

50
Q

Which entities shall manage the Special Health Fund?

A

Province/City-wide Health Systems

51
Q

The National Government is to provide technical and financial support to LGUs that commit the province-wide integration in the first ______ years

52
Q

The 6-year technical and financial support of the National Government to the LGUs will consist of what 2 activities?

A
  1. Managerial integration of province/city-wide systems (first 3 years)
  2. Financial integration (next 3 years)
53
Q

All local health systems will be integrated through an issuance of an E.O. by the President only upon positive recommendation by what and who?

A

An independent study and the Secretary of Health

54
Q

PhilHealth payments shall accrue to the Special Health Fund and be credited as the ______ of the LGU?

A

Annual Regular Income (ARI)

55
Q

What 4 entities are responsible for developing and planning the expansion of existing and new allied health-related degree and training programs?

A

CHED, TESDA, PRC and DOH

56
Q

What 4 entities are responsible for regulating the number of enrollees in each program based on the health needs of the population especially those in underserved areas?

A

CHED, TESDA, PRC and DOH

57
Q

What 2 entities shall expand scholarship grants for allied and health-related undergraduate and graduate programs?

A

CHED and DOH

58
Q

Scholarships shall be based on the needed _____ of national/local health managers and health professionals

A

Cadre (a small group of people specially trained for a particular purpose or profession)

59
Q

Who shall be given priority in the scholarship distribution?

A

Bona fide residents of unserved/underserved areas or members of indigenous groups

60
Q

What 2 entities shall set up a registry of medical and allied health professionals indicating their current number of practitioners and location of practice?

A

PRC and DOH

61
Q

What 3 entities shall reorient the ff.:

  1. medical and allied medical professional education
  2. health professional certification and regulation
A

CHED, PRC, and DOH

62
Q

All graduates who are recipients of a government-funded scholarship program shall be bound by what contract?

A

Return Service Agreement (RSA)

63
Q

Those under the Return Service Agreement are required to serve how many years?

A

At least 3 full years (w/ compensation and supervision of the DOH)

64
Q

Those under the Return Service Agreement are required to serve for 3 years in what areas?

A

Priority areas in the public sector

65
Q

Those who’ve served the initial 3 years of the Return Service Agreement shall be incentivized by doing what?

A

Serving for an additional 2 years

66
Q

This system shall be created to support local public health systems in addressing their human resource needs

A

National Health Workforce (NHW) Support System

67
Q

The National Health Workforce (NHW) Support System shall prioritize deployment to what areas?

A

Geographically Isolated and Disadvantaged Areas (GIDAs)

68
Q

There should be _______ pricing of health goods and services

A

Transparent

69
Q

These shall procure drugs and devices guided by price reference indices, following centrally negotiated prices, sell them following the prescribed maximum mark-ups, and submit to DOH a price list of all drugs and devices procured and sold

A

DOH-owned health care providers

70
Q

This board is composed of representatives from the DOH,
PhilHealth and the Department of Trade and Industry (DTI), among others

A

Independent price negotiation board

71
Q

T or F: The negotiated price in the framework contract shall be applicable for all health care providers under CHD

A

False (DOH)

72
Q

These shall be required at all times to carry the generic equivalent of all drugs in the Primary Care Formulary

A

Drug Outlets

73
Q

These shall be required to provide customers with a list of therapeutic equivalents and then corresponding prices when fulfilling prescriptions or in any transaction

A

Drug Outlets

74
Q

A coordination mechanism between PhilHealth, PHIs and HMOs shall be set up to ensure that no benefits shall be unnecessarily ________

75
Q

Government hospitals are required to operate with not less than _____% of their bed capacity as basic or ward accommodation

A

90% (90 basic: 10 non-basic)

76
Q

Specialty Hospitals are required to operate with not less than ____% of the bed capacity as basic or ward accommodation

A

70% (70 basic: 30 non-basic)

77
Q

Private Hospitals are required to operate with not less than _____% of their bed capacity as basic or ward accommodation

A

10% (10 basic: 90 non-basic)

78
Q

T or F: Only government hospitals are required to regularly submit a report on the allotment/percentage of their bed capacity to basic or ward accommodation to DOH

A

False (ALL hospitals)

79
Q

The _____ shall institute a licensing and regulatory system for stand-alone health facilities, including those providing ambulatory and primary care services

80
Q

This refers to the provision of regular meals, beds in shared a room, fan ventilation, and a shared toilet and bath

A

Basic Accomodation

81
Q

This refers to features of the health services that provide comfort or convenience such as private accommodation, air conditioning, telephone, and choice of meals

82
Q

The DOH shall strengthen national efforts in providing a ______ and _______ approach to health development

A

Comprehensive and Coordinated

83
Q

The DOH puts emphasis on scaling up _______ and preventive care

A

Health Promotion

84
Q

The DOH shall transform its existing Health Promotion and Communication Service into a full-fledged Bureau called?

A

Health Promotion Bureau (to improve health literacy and mainstream health promotion and protection)

85
Q

There should be a mandatory use of ______ systems and submission of health and financial data

A

IT (information technology)

86
Q

This shall be required for policies, programs, and projects that are crucial in attaining better health outcomes or those that may have an impact on the health sector

A

Health Impact Assessment (HIA)

87
Q

This process shall be institutionalized as a transparent priority setting mechanism that shall be recommendatory to the DOH and PhilHealth

A

Health Technology Assessment (HTA)

88
Q

Investments on any health technology or development of any benefit package by the DOH and PhilHealth shall be based on the positive recommendations of what?

A

Health Technology Assessment (HTA)

89
Q

This bureau shall formulate a framework strategy for health promotion

A

Health Promotion Bureau

90
Q

Within how many years from the effectivity of this Act shall the cost of implementing health promotion programs be at least 1% of the DOH’s total budget appropriations?

91
Q

Within 2 years from the effectivity of this Act, the cost of implementing health promotion programs shall be at least ____% of the DOH’s total budget appropriations

92
Q

The schools under the supervision of DepEd are designated as ________ for the purpose of this Act

A

Healthy Settings

93
Q

This entity shall formulate programs and modules on health literacy and rights to be integrated into the existing school curricula

A

DepEd in coordination with the DOH

94
Q

These are directed to enact stricter ordinances that strengthen and broaden existing health policies and implement effective programs that promote health literacy and healthy lifestyle among their constituencies

95
Q

All health service providers and insurers are to maintain a _____ to be electronically uploaded on a regular basis through the interoperable system

A

Health Information System (HIS)

96
Q

What are the 4 elements in a Health Information System?

A

» Enterprise resource planning
» Human resource information
» Electronic health records
» Electronic prescription log

97
Q

What element comprises of the HEIGHT dimension in the box model?

A

Financial Coverage

98
Q

What element comprises of the WIDTH dimension in the box model?

A

Service Coverage

99
Q

What element comprises of the LENGTH dimension in the box model?

A

Population Coverage

100
Q

The health information system shall be developed and funded by the ____ and _____

A

DOH and PhilHealth

101
Q

RA 11223 was recently signed under who’s administration?

A

Pres. Duterte

102
Q

This law states that every Filipino shall automatically be a member of what?

A

PhilHealth

103
Q

T or F: HMOs are private while PhilHealth is public (government)

104
Q

This makes PhilHealth billings predictable as there is a code for every disease possible

A

DRG (diagnosis related groups)

105
Q

RA 11223’s dry run period should have been done in 2020 but was stopped due to what?

MTLBE (30 decks)

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